Many youth at risk for unwanted pregnancies, sexually transmitted infections and HIV do not seek preventive health care services at traditional health clinics. A new research review finds that if reproductive health services were more easily accessible, youth would be more likely to use them.
The emotional and reproductive changes that come with adolescence also come with increased health risks. Every year, about 16 million girls aged 15 to 19 give birth, and 40 percent of all new HIV infections in 2009 were among youth between the ages of 15 and 24, according to the World Health Organization.
Lead author Donna Denno, M.D. said the new review, which appears in the Journal of Adolescent Health, provided an opportunity to learn about strategies used in many different countries to combat these risks.
This is especially critical since U.S. adolescents suffer from substantially higher pregnancy rates, for example, compared to most other developed countries, even when rates of sexual activity are similar, explained Denno, associate professor in the departments of pediatrics and global health at the University of Washington in Seattle.
The reviewers evaluated 20 international studies of adolescents and young adults to determine what types of policies and programs delivered outside of traditional health facilities would increase their use of HIV or reproductive health services.
One-quarter of the studies looked at delivering emergency contraception (EC) through community-based pharmacies without a doctors prescription. Following this practice, there was an overall uptick in the use of EC of 17 percent in France and of more than 50 percent in British Columbia. While overall use of EC did not increase in the U.K., youth were able to obtain the pills in a more timely fashion, increasing their effectiveness.
In another study, when health workers in Louisiana distributed almost a half-million condoms to neighborhoods high in IV-drug use, those in the intervention areas were 37 percent more likely to have used condoms during their last intercourse. One study of a mail-based sexually transmitted infection screening program in the Netherlands achieved a 40 percent response rate.
Unfortunately, though, U.S. public health policies offer adolescents much less access to reproductive health services in community settings than in other parts of the world, said Heidi Jones, Ph.D., an assistant professor at the CUNY School of Public Health at Hunter College.
Public health policies related to improving reproductive health in the United States are not made based on scientific evidence and rational thought, but rather reproductive health issues are used as pawns in the political arena to garner support for political candidates, she said. Amazingly, emergency contraception has been used in a similar vein, with even the FDA acting against the recommendations of its scientific advisory board.
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Denno D.M., et al. 2012. Reaching youth with out-of-facility HIV and reproductive health services: a systematic review. Journal of Adolescent Health. doi:10.1016/j.jadohealth.2012.01.004xx